79 BOSTON STREET - TRASH COMPLAINT . a
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHrNGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN if SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By-.
Complaint Number: 2049
Complainant
Address: Phone:
Investigated By: _ Date:
Property Owner/Occupant Name_ Telephone#: